IMMUNIZATION

IMMUNIZATIONIMMUNIZATION

Immunization

• Immunization– Deliberate provocation of an adaptive immune

response by introducing antigen into the body

• Vaccination– Deliberate induction of an adaptive immune

response to a pathogen by injecting a vaccine, a killed or attenuated form of the pathogen

Vaccination

• The best known and the most successful application of immunological principles to human health

Vaccine (from vacca, Latin for cow)• Dr. Edward Jenner, 1796• Material from cowpox lesions to vaccine an 8 y/o

boy vs smallpox (1st vaccine)

Rabies Vaccine• Dr. Louis Pasteur, 1885• Vaccinated a 9 y/o boy

who had been bitten by a rabid dog

• Altered preparations of microbes could be used to generate enhanced immunity vs. the fully virulent organism

Ultimate goal: eradication of disease

Immediate goal: prevention of disease

TYPES OF

PROTECTION INDUCED:1. Complete protection for life

2. Partial protection (booster doses)

GOALS CAN BE ACHIEVED IN 2 WAYS:

1. ACTIVE immunization

2. PASSIVE immunization

ACTIVE IMMUNIZATIONACTIVE IMMUNIZATION

• Involves administration of all or part of a microorganism or a modified product of that microorganism (toxoid, purified antigen, antigen produced by genetic engineering, to evoke an immunologic response mimicking that of the natural infection but which usually presents little or no risk to the recipient.

PASSIVE IMMUNIZATIONPASSIVE IMMUNIZATION

• the administration of preformed antibody to a recipient for the prevention and amelioration of infectious diseases ( temporary protection)

Immunity

Active Passive

Injection of an antigen Injection of preformed

(vaccine) antibiotics (gammaglobulins)

Protection produced by the Protection transferred from person’s own immune another person or animal

System

Usually permanent Temporary protection that wanes with time

Passive Immunity

SOURCES

• Almost all blood or blood products

• Homologous pooled human antibody (immune globulin)

• Homologous human hyperimmune globulin

• Heterologous hyperimmune serum (antitoxin)

• Transplacental most important source in infancy

ACTIVE IMMUNIZATIONACTIVE IMMUNIZATION

- Live attenuated viral vaccine – Measles, MMR, OPV, Varicella

- Inactivated viral vaccine – Influenza , Hep A, IPV, Hep B (recombinant DNA)

- Detoxified exotoxin (Toxoid) – Diphtheria, Tetanus- Purified protein antigens – acellular Pertussis, Hep B- Whole cell pertussis vaccine – DTP- Inactivated acellular pertussis vaccine – DTaP- Capsular polysaccharide – Typhoid- Protein conjugated polysaccharide vaccine – Hib,

Pneumococcal- Live attenuated bacterial vaccine – BCG (Bacille Calmette

Guerin)

ACTIVE IMMUNIZATION - GeneralitiesACTIVE IMMUNIZATION - Generalities

• Contraindications to ALL VACCINES: - serious allergic reaction (anaphylaxis) after a

previous vaccine dose- serious allergic reaction to a vaccine component

• Precautions : - moderate or severe acute

illness with or without fever


Contraindications to ALL LIVE VACCINES:

1. immunocompromised patients

2. patients given immunoglobulin and blood products for the past 3 months

3. pregnancy and possibility of getting pregnant within 3 months

4. household contacts of immunocompromised patients* (OPV)


Simultaneous administration of Multiple Vaccines:

• no contraindications for multiple vaccines routinely recommended

• immune response to one vaccine generally does not interfere with other vaccines


• There should be an interval of 28 days between administration of live vaccines

• After 7th birthday, Td is recommended for both primary and booster vaccination

• Interchangeability of vaccine products is allowed for primary and booster doses


Lapsed immunizations:

• in general, intervals between vaccine doses that exceed those that are recommended do not adversely affect the immunologic response, provided immunization series is completed

EXPANDED PROGRAM ON IMMUNIZATION (EPI) EXPANDED PROGRAM ON IMMUNIZATION (EPI) by the Department of Healthby the Department of Health

VACCINE MINIMUM AGE

DOSE (NO) ROUTE AND SITE

OF ADMINIST-

RATION

MINIMUM INTERVAL BETWEEN

DOSES

REMARKS

BCG 1 Birth; or any time after birth

0.05 ml for NB; 0.1 ml for infants (1)

Intradermal; deltoid R arm

Vaccine destroyed by heat & sunlight

DTP 6 weeks 0.5 ml (3) IM; upper outer portion of thigh

4 weeks Vaccine damaged by heat, freezing

POLIO 6 weeks 2 drops (3) PO; mouth 4 weeks Vaccine easily damaged by heat


VACCINE MINIMUM AGE

DOSE (NO) ROUTE AND SITE

OF ADMINIST-

RATION


DOSES

REMARKS

HEP B 6 weeks or at birth

Follow manufactur-er’s instructions 0.5 ml (3) - 0,1 & 6 months

IM; anterolateral aspect of thigh

Vaccine destroyed by heat or freezing

MEASLES 9 months 0.5 ml (1) SC; outer part of the thigh

Vaccine easily damaged by heat


VACCINE MINIMUM AGE

DOSE (NO) ROUTE AND SITE OF

ADMINIST-RATION


DOSES

REMARKS

BCG 2 At school entry, whether or not child has BCG scar

0.1 ml (1) ID; L deltoid Vaccine destroyed by heat or sunlight

TETANUS TOXOID

Women of childbrearing age

0.5 ml (5) IM; deltoid region

TT1 at 1st contact

TT2 at least 4 weeks after TT1

TT3 at least 6 wks after TT2

TT4 at least 1 year after

TT5 at least 1 year after

Vaccine easily damaged by heat & sunlight; given for those not given primary immunization in infancy and childhood

Summary of Rules for Childhood Summary of Rules for Childhood ImmunizationImmunization

BCG Vaccine:- live attenuated bacterial vaccine- at birth or anytime after birth- 0.05 ml ID from birth to 4 weeks; 0.1 ml ID beyond 1 month at right upper deltoid- booster dose given at school entry, 0.1 ml ID at left upper deltoid

Contraindications: immunodeficiency, progressive dermatoses

Reaction: abscess at the site; axillary lymphadenopathy


BCG Vaccine:

Usual reactions:• induration: 2 – 4 wks• pustule formation: 5 – 7

wks• scar formation: 2 – 3

months

Accelerated Reactions:• induration: 2-3 days• pustule formation: 5-7

days• scar formation: 2-3 weeks


Hepatitis B vaccine:- inactivated viral antigen- 0, 1 & 6 months- if mother is HBsAg(+): give HBIg & Hep B #1 within

12 hours of birth, Hep B #2 at 1 month and Hep B #3 at 6 months of age- children and adolescents who have not been vaccinated with Hep B may begin series during any visit

Contraindication: anaphylactic reaction to previous dose

Reactions: pain and swelling at site, fever


Diphtheria, Tetanus & Pertussis:

DTaP– DT are toxoids– aP is acellular pertussis

DTP or DTwP– DT are toxoids– P is killed or inactivated whole cell pertussis



Usual Side Effects:– fever up to 72 hours (low to moderate grade)– restlessness and irritability– local reaction: pain and swelling at the site of injection

Contraindications:– encephalopathy (coma, prolonged seizures &

decreased level of consciousness) within 7 days of administration of previous dose

– anaphylactic shock after a previous dose– progressive neurologic disorders: infantile spasms,

uncontrolled epilepsy, progressive encephalopathy



Precautions :– fever greater than 40°C within 48 hours after

administration of a previous dose– collapse or shock-like state within 48 hours after

receiving a previous dose– seizures within 3 days of receiving a previous dose– persistent, inconsolable crying lasting for 3 hours and

within 48 hours after receiving a previous dose– moderate or severe acute illness with or without fever


Poliomyelitis Vaccine:

2 types of vaccines:1. Oral Polio Vaccine (OPV)

- live attenuated (Sabin)- 0.5 ml orally; or 2 drops (using multiple dose)

• Absolute contraindications:1. altered immune states (malignancies [lymphoma,

leukemia], therapy with alkylating agents, metaboltes, high dose steroids, radiation, HIV/AIDS)

2. pregnancy3. household contacts of immunocompromised patients

• Relative contraindications: vomiting and diarrhea• Adverse Reaction: paralysis


Poliomyelitis Vaccine:

2. Inactivated or Killed Polio Vaccine (IPV)

- given IM

IPV was recommended to decrease the incidence of vaccine-associated paralytic polio (VAPP)


Measles Vaccine:- live attenuated - 0.5 ml SC- given at 9 months but may be given as early as 6 months during epidemics

Adverse reactions:1. fever with or without rashes (5-12 days after

administration)2. hypersensitivity reaction

Contraindication: immunocompromised state, pregnancyRelative Contraindication: untreated active tuberculosis


Measles, Mumps, Rubella (MMR) Vaccine:- live attenuated - 0.5 ml SC- given at 12-15 months; a booster dose is recommended at 4-6 years old

Reactions:1. fever with or without rashes (5-12 days after

administration - measles)2. fever, swelling of parotid gland (mumps)3. fever, mild rash, transient arthritis or arthralgia,

post-auricular lymphadenopathy (rubella)


Measles, Mumps, Rubella (MMR) Vaccine:

Reasons for giving 2 doses of MMR:

1. only 87-90% of children actually receive the measles vaccine

2. 5% of children who receive the first vaccine won’t develop immunity

3. children who had an immune response to the first dose could get a “booster” effect

Contraindications: same as other live vaccines


Varicella Vaccine:- live attenuated - 0.5 ml SC- routinely given at age 12 months and up but can be given as early as 9 months- can be given within 5 days of exposure- a patient given varicella vaccine can also develop shingles although the incidence is less frequent and less severe as compared to the actual varicella infection- varicella vaccine prevents moderate to severe cases

of chickenpox


Varicella Vaccine:

Recommendations:1. single dose for ages 1-12 years2. 2 doses 6-10 wks apart in children >13 years

Safety of Varicella vaccine:1. the virus is so weak that it is not transferred from

someone who got the vaccine to another person2. it can be given to children who are living in the

home of someone whose immune system is weak3. may also be given to patients whose mother is

pregnant


Varicella Vaccine:

Reactions:

-may develop few varicella-like lesions about 1 month after vaccination


Hemophilus influenzae b (Hib) Vaccine:- polysaccharide protein conjugate

- 0.5 ml IM given at 2, 4, 6 and 12 - 15 months old

Reactions: low grade fever (2%)

pain and swelling (10-15%)


Pneumococcal Vaccine:- PCV is given at 2, 4, 6 and 12 -15 months or 1 dose at

2 yrs of age- PPV is given for children 2 yrs and above- 0.5 ml IM

Indications:1. patients undergoing splenectomy2. sickle cell disease3. asplenia4. HIV5. Routinely for children 2 months and above


Hepatitis A Vaccine:

- inactivated viral antigen

- given to children 1 year and above in 2 doses:

- first dose: anytime after 1 year

- 2nd dose: (booster) 6-12 months after first dose

- Dose for 1-18 years: 0.5 ml IM (720 U)

for >19 years: 1 ml IM (1440 U)


Hepatitis A Vaccine:

Indications:

1. persons traveling to areas with high prevalence of Hepatitis A

2. occupational hazards

3. hemophiliacs – contacts of infected persons

Reactions: pain and local swelling


Influenza Vaccine:- inactivated vaccine- dose:

for 3 years and above: 0.5 ml IM or SCfor 6 – 36 months: 0.25 ml IM or SC

- should be administered before the start of flu season (Feb to June)

Indications:1. prophylaxis in children older than 6 months and adults2. over 60 years3. suffer from disease of cardiovascular system, metabolic

disease, cystic fibrosis, chronic respiratory disease, chronic renal insufficiency


Rotavirus Vaccine:

- inactivated vaccine

- given at 2, 4, and 6 months old

- 0.5 ml IM

Human Papilloma Virus Vaccine:

- inactivated vaccine

- given from 9 to 26 yrs old at 0, 1, and 4months

- 0.5 ml IM

IMMUNIZATION

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